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E-Veri <br />Company ID Number: 486671 <br />:$� b�lll�lliTo <br />To be accepted as a participant in E-Verify, you should only sign the Employer's Section <br />of the signature page. If you have any questions, contact E-Verify at 888464-4218. <br />Employer Ziolkowski Construction, Inc. <br />ill Favors <br />Name (Please Type or Print) <br />Electronicall Signed <br />!tie <br />1/10/2012 <br />ignature <br />Date <br />Department of Homeland Security — Verification Division <br />SCIS Verification Division <br />Name (Please Type or Print) <br />Electronically Signed <br />itle <br />01/10/2012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Com an Name: <br />iolkowski Construction, Inc. <br />Company Facility Address: <br />060 Ralph Jones or. <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />County or Parish: JSTJOSEPH <br />Employer Identification <br />Number: <br />51445992 <br />Page 12 of 13 1 E-Verify MOU for Employer i Revision Date 09/01/09 www.dhs.gov/E-Verify <br />